It is a common and often frustrating experience for pregnant individuals to struggle with urination, feeling an urge to go but finding it difficult to start the stream or feeling incomplete emptying afterward. This problem, known as urinary hesitancy or retention, is a direct result of the dramatic physical and hormonal changes supporting the developing fetus. While the symptom of frequent urination is widely expected, the difficulty in actually emptying the bladder can be confusing. Understanding the specific mechanisms behind this discomfort can help in managing it effectively and recognizing when a medical concern might be present.
Mechanical Obstruction from Uterine Growth
The physical growth of the uterus is a primary mechanical factor that interferes with normal bladder function, leading to difficulty in urination. The bladder and the uterus share space within the bony confines of the pelvis, meaning any change in the size or position of one directly impacts the other. This mechanical pressure tends to cause issues during two distinct periods of pregnancy.
In the first trimester, the uterus often settles backward, or retroverts, into the pelvic cavity, where it presses directly against the bladder neck and the urethra. This can lead to a temporary but significant obstruction of the urinary tract, making it hard to start the flow of urine. As the uterus grows larger and rises out of the pelvis and into the abdominal cavity around the second trimester, this specific pressure point is usually relieved, and the urinary difficulty often subsides.
The difficulty typically returns in the final weeks of the third trimester when the fetal head “engages,” or drops, lower into the pelvis in preparation for birth. This engagement creates a new point of pressure, pushing the lower portion of the uterus and the presenting fetal part onto the bladder and urethra. This compression reduces the functional capacity of the bladder, explaining the increased frequency of urination, and physically obstructs the urethra, making complete voiding challenging.
The Role of Pregnancy Hormones on Bladder Function
Beyond the physical pressure exerted by the growing uterus, the hormonal landscape of pregnancy significantly contributes to difficult urination by altering the function of the urinary tract muscles. The hormone progesterone surges throughout pregnancy to relax smooth muscle tissue across the body, a process necessary to prevent premature uterine contractions. This relaxing effect extends to the smooth muscle walls of the bladder and the ureters.
The detrusor muscle, the main muscle in the bladder wall responsible for contracting to expel urine, is affected by progesterone. When the detrusor muscle is relaxed, it becomes less efficient at contracting forcefully enough to push all the urine out, often leaving residual urine behind. This inefficiency leads to a sensation of incomplete emptying.
This smooth muscle relaxation also affects the ureters, the tubes that carry urine from the kidneys to the bladder, causing them to widen and slow the flow of urine. This slowing of movement is known as urinary stasis. The combination of a less-efficient detrusor muscle and urinary stasis allows residual urine to accumulate, further contributing to the feeling of incomplete voiding and increasing the risk for bacterial growth.
Practical Strategies for Complete Emptying
Since the causes of difficult urination are physical and hormonal, simple changes in posture and habit can offer immediate and significant relief by helping to overcome mechanical obstruction and muscle inefficiency.
The Pee Lean
One of the most effective strategies is the “Pee Lean,” which involves leaning forward while sitting on the toilet. This action changes the angle of the uterus and urethra, momentarily reducing the pressure on the bladder neck. This allows for a stronger, more complete stream.
Double Voiding
After the initial stream has finished, practicing “Double Voiding” helps ensure the bladder is fully empty. This technique involves sitting quietly for a few moments after the first void and then attempting to urinate a second time, often with another forward lean. This second attempt helps expel residual urine left due to the detrusor muscle’s reduced contractility. Applying light pressure with the hand over the lower abdomen, known as suprapubic pressure, can also gently assist the bladder in completing its contraction.
Hydration
Maintaining consistent and adequate hydration is also an effective strategy. Dehydration concentrates urine, which can irritate the bladder lining and make it more difficult to void comfortably. Drinking enough water keeps the urine diluted, which is less irritating to the urinary tract and helps promote regular flushing to prevent bacterial buildup.
Recognizing Serious Complications
While some difficulty in urination is a common pregnancy discomfort, certain signs indicate a serious complication that requires immediate medical attention. The inability to pass urine at all, known as acute urinary retention, is a urological emergency that causes severe pain and discomfort in the lower abdomen. If you experience a complete inability to void, contact a healthcare provider immediately.
Another concern is a Urinary Tract Infection (UTI), which is more common in pregnancy due to hormonal changes and urinary stasis. Signs of a simple bladder infection (cystitis) include:
- Pain or a burning sensation during urination.
- A sudden and persistent urge to void.
- Urine that appears cloudy.
- Urine that has a strong, foul odor.
These symptoms are distinct from typical pregnancy-related frequency and hesitancy.
If a bladder infection progresses to the kidneys, it becomes pyelonephritis, which poses risks to both the pregnant person and the fetus. Symptoms suggesting a kidney infection include a fever, chills, nausea, vomiting, and persistent pain in the lower back or side, often just under the ribs. If these severe symptoms are present, especially combined with painful or difficult urination, seeking immediate medical care is necessary.